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. 2017 Mar 23;2017(3):CD003347. doi: 10.1002/14651858.CD003347.pub3
Methods Double blind randomised trial.
Participants N = 95 cancer participants with any primary tumour histology (64 with prostate cancer, 19 with breast cancer and 10 with other cancers). Metastatic bone lesions confirmed by bone scan and radiographs. Patients were referred for painful skeletal metastases.
(46 on 89Sr, 49 on placebo).
Interventions 1. 89Sr at 150 MBq dose administered iv + external beam radiotherapy.
2. Placebo administered iv + external beam radiotherapy.
Treatment injection administered on the first day of radiotherapy. External beam radiotherapy at a maximum of 2 sites, fractionated as 3 Gy/fraction in 10 fractions.
Follow up: 3 months.
Outcomes Physician‐assessed subjective progression at 3 months and 6 months.
Pain scale of the QLQ‐C30 questionnaire assessed at 3 and 6 months.
Analgesic score based on the type and dose of all analgesics.
Quality of life with the QLQ‐C30 questionnaire assessed at 3 and 6 months.
Haematologic toxicity graded according to the WHO recommendations, assessed at 6 weeks, 3 and 6 months.
Notes 2 patients ineligible in the 89Sr group, 4 patients didn't receive treatment with placebo.
6 patients were not evaluable on the 89Sr group, 4 patients were not evaluable on the placebo group.
Risk of bias
Bias Authors' judgement Support for judgement
Random sequence generation (selection bias) Unclear risk Not described.
Allocation concealment (selection bias) Unclear risk Not described.
Blinding (performance bias and detection bias) Patients Low risk The study is described as double blind but no further details are provided.
Blinding (performance bias and detection bias) Study researchers Low risk The study is described as double blind but no further details are provided.
Blinding (performance bias and detection bias) Outcome assessment Unclear risk Not described.
Incomplete outcome data (attrition bias) All outcomes Low risk The number and reasons of non‐evaluable patients are described, but the number is high with respect to the evaluable patients, particularly for the main outcome where there is only data for 69 out of 95 participants, and thus results are unreliable.

Gy: Gray iv: intravenous MBq: MegaBecquerel MCi: MegaCurie QoL: quality of life RTOG: Radiation Therapy Oncology Group VAS: visual analogue scale